Differences in Racial and Ethnic Disparities Between First and Repeat Kidney Transplantation

Shaifali Sandal; JiYoon Ahn; Yusi Chen; Valerie Thompson; Tanjala S. Purnell; Marcelo Cantarovich; Maya N. Clark-Cutaia; Wenbo Wu; Rita Suri; Dorry L. Segev; Mara McAdams-DeMarco

doi:10.1097/tp.0000000000005051

journal article May 21, 2024

Differences in Racial and Ethnic Disparities Between First and Repeat Kidney Transplantation

Shaifali Sandal

JiYoon Ahn Yusi Chen

Valerie Thompson Tanjala S. Purnell Marcelo Cantarovich Maya N. Clark-Cutaia Wenbo Wu

Rita Suri

Dorry L. Segev

Mara McAdams-DeMarco

Transplantation Vol. 108 No. 10 pp. 2144-2152 · Ovid Technologies (Wolters Kluwer Health)

View at Publisher Save 10.1097/tp.0000000000005051

Abstract

Background.
Recent data suggest patients with graft failure had better access to repeat kidney transplantation (re-KT) than transplant-naive dialysis accessing first KT. This was postulated to be because of better familiarity with the transplant process and healthcare system; whether this advantage is equitably distributed is not known. We compared the magnitude of racial/ethnic disparities in access to re-KT versus first KT.

Methods.
Using United States Renal Data System, we identified 104 454 White, Black, and Hispanic patients with a history of graft failure from 1995 to 2018, and 2 357 753 transplant-naive dialysis patients. We used adjusted Cox regression to estimate disparities in access to first and re-KT and whether the magnitude of these disparities differed between first and re-KT using a Wald test.

Results.
Black patients had inferior access to both waitlisting and receiving first KT and re-KT. However, the racial/ethnic disparities in waitlisting for (adjusted hazard ratio [aHR] = 0.77; 95% confidence interval [CI], 0.74-0.80) and receiving re-KT (aHR = 0.61; 95% CI, 0.58-0.64) was greater than the racial/ethnic disparities in first KT (waitlisting: aHR = 0.91; 95% CI, 0.90-0.93; P
interaction = 0.001; KT: aHR = 0.68; 95% CI, 0.64-0.72; P
interaction < 0.001). For Hispanic patients, ethnic disparities in waitlisting for re-KT (aHR = 0.83; 95% CI, 0.79-0.88) were greater than for first KT (aHR = 1.14; 95% CI, 1.11-1.16; P
interaction < 0.001). However, the disparity in receiving re-KT (aHR = 0.76; 95% CI, 0.72-0.80) was similar to that for first KT (aHR = 0.73; 95% CI, 0.68-0.79; P
interaction = 0.55). Inferences were similar when restricting the cohorts to the Kidney Allocation System era.

Conclusions.
Unlike White patients, Black and Hispanic patients with graft failure do not experience improved access to re-KT. This suggests that structural and systemic barriers likely persist for racialized patients accessing re-KT, and systemic changes are needed to achieve transplant equity.

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References

Details

Published: May 21, 2024
Vol/Issue: 108(10)
Pages: 2144-2152

Authors

S

Shaifali Sandal

Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.; Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.; Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.

J

JiYoon Ahn

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

Y

Yusi Chen

Department of Surgery, NYU Grossman School of Medicine and Langone Health, New York, NY.

V

Valerie Thompson

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

T

Tanjala S. Purnell

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.; Department of Surgery, NYU Grossman School of Medicine and Langone Health, New York, NY.

M

Marcelo Cantarovich

Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.; Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.

M

Maya N. Clark-Cutaia

New York University Rory Meyers College of Nursing, New York, NY.

W

Wenbo Wu

Department of Population Health, NYU Grossman School of Medicine and Langone Health, New York, NY.

R

Rita Suri

Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.; Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.; Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.

D

Dorry L. Segev

Department of Surgery, NYU Grossman School of Medicine and Langone Health, New York, NY.; Department of Population Health, NYU Grossman School of Medicine and Langone Health, New York, NY.

M

Mara McAdams-DeMarco

Department of Surgery, NYU Grossman School of Medicine and Langone Health, New York, NY.; Department of Population Health, NYU Grossman School of Medicine and Langone Health, New York, NY.

Cite This Article

Shaifali Sandal, JiYoon Ahn, Yusi Chen, et al. (2024). Differences in Racial and Ethnic Disparities Between First and Repeat Kidney Transplantation. Transplantation, 108(10), 2144-2152. https://doi.org/10.1097/tp.0000000000005051

Differences in Racial and Ethnic Disparities Between First and Repeat Kidney Transplantation

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